The Empire of Trauma: An Inquiry into the Condition of Victimhood

Fassin, D. and Rechtman, R. The Empire of Trauma: An Inquiry into the Condition of Victimhood . Princeton : Princeton University Press , 2009 £16.95 (pbk ) xii+304 pp . ISBN 978-0-691-13753-7 The authors write, “the concept of trauma profoundly transforms the moral framework of what constitutes humanity” (p.21). This book is about that transformation, whereby trauma colonises the meaning of suffering. The Empire of Trauma makes empirical a ritualistic assertion among students of trauma: “Trauma has become a major signifier of our age” (p.xi). In doing so, it effectively indicts sociologists for not giving the subject more attention. Fassin and Rechtman are both doctors, as well as anthropologists. They divide their book into four parts. The first and longest section is a social and intellectual history of psychological trauma from the late 1800s to 1980, when posttraumatic stress disorder (PTSD) was entered into the DSM-III. The authors trace how the science of trauma has followed moral sentiment, giving special emphasis to war psychiatry and diagnosis for disability claims. In the early period, trauma victims were treated with suspicion. Westerners viewed them as despicable individuals — cowards, malingerers, and profiteers — who failed their duty to serve the nation in its military or its industrial army. However, people’s opinion of trauma victims changed significantly during the 1970s, first in the US, culminating in the PTSD diagnosis. Fassin and Rechtman’s history is familiar, but rarely found in a single volume. And their version includes many noteworthy surprises. For example, the common position is that European military doctors were unprepared to handle the number of psychiatric casualties that the Great War claimed. Fassin and Rechtman argue that in truth, the military doctors were prepared as much as they cared to be. Doctors did not believe most trauma claims, so rather than offering therapy, they only cared to discipline malingerers and cowards back to service. Also, in explaining the PTSD diagnosis, the authors emphasise the role of sexual politics, psychiatry’s interest in appealing to the oppressed, and the attempts of the US military to save face after the Vietnam War. Typically, scholars reduce the “discovery” of PTSD to the political agenda of anti-war veterans and sympathetic psychiatrists. Fassin and Rechtman’s history instead suggests that anti-war politics was part of a widespread cultural change leading to the diagnosis. The authors characterise the PTSD diagnosis as “the consecration of the event” (p.84). They write, “The event had become the sole cause of pathology. Suspicion had definitely disappeared” (p.87). Fassin and Rechtman are wrong, even by their own facts, that suspicion has definitely disappeared, but nonetheless, an epic shift has occurred. Some events, it is thought, are so despicable that they could traumatise anyone; PTSD implies that “something of the human resists all forms of moral destruction” (p.95). Events traumatise because they are an affront to a universal and indestructible ethical orientation — one that the victims, the perpetrators, and the witnesses share. If all share an ethical position, it is objective, and violations of that universal humanity are objectively inhumane. Traumatic disorder is both evidence of a common humanity and the experience of objective inhumanity. Fassin and Rechtman explain that trauma “holds ethical truth that clinical practice can finally confirm: trauma is itself the proof of an unbearable experience” (p.93). Trauma, then, can be used as a moral and political “resource” (p.11). The final three sections of the book explore different ways in which the French have used trauma as a resource. Part 2 deals with “the politics of reparation” surrounding the explosion of a chemical plant in Toulouse on September 21, 2001. According the Fassin and Rechtman, with this event “trauma was freed from its medical roots” in France, which involved a move “from diagnosing trauma to simply declaring it” (p.130, 137). In Toulouse, trauma was a way for victims to gain automatic recognition for their suffering and a way for any citizen to demand compensation. Part 3 deals with “the politics of testimony” with particular consideration of Médicins Sans Frontières, Médicins du Monde and violence in Kosovo and Palestine. This part illustrates that the humanitarian psychiatrist is also a forensic scientist. His or her witness of trauma symptoms, whether through treatment or research, has become public testimony of war crimes. While this represents a new kind of global solidarity, it also means, as the authors document, that “bearing witness” is often prioritised over treatment. The last part of the book deals with “the politics of truth”. Because officials do not trust the refugee’s own words, psychiatrists, by diagnosing PTSD, now help the French government determine who has suffered torture. Fassin and Rechtman worry that while psychiatrists might help some gain asylum, the sterile language of clinical diagnosis, compared to the refugee’s personal description, might not evoke empathy in those deciding an asylum seeker’s case. Here lies the imperialism of trauma for Fassin and Rechtman: it silences. First, trauma is the single language of suffering. In that way, it is inhumane. “[I]t obscures the diversity and complexity of experiences. It conceals the way in which experiences take on multiple meanings in a collective history, in a personal life story, in a lived moment” (p.281). Second, the application of the concept is selective, and the suffering of those not perceived as traumatised is ignored. For example, the individuals most affected by the explosion in Toulouse — the plant workers — were denied claims to trauma. Humanitarian psychiatry, as the authors show, more readily applies trauma to Europeans than Africans. When trauma is denied, so is the victim’s common humanity. Though often difficult and sometimes overdrawn, Empire of Trauma is a benchmark in the study of trauma. I hope many sociologists read this book and take it as a testament to the magnitude of the subject matter. Trauma is too important to ignore. Both the interest in and experience of trauma are complex sociological realities and significant features of the present historical moment. The attention to trauma, as Fassin and Rechtman explain, is not merely ‘fashion’. “It is rather the sign of a human society that places the issue of suffering at the heart of its common concerns” (p.153).